Tag: health insurance

ClaimLinx is a full-service insurance company. We take care of anything and everything, such as finding the best possible employer-paid benefits and competitive health insurance rates. But at the core of the ClaimLinx Solution our consultants use, is the third party administration we offer employers. Today’s blog from ClaimLinx explains what a third-party administrator does for businesses.

Definition of a Third-Party Administrator

A third-party administrator accepts and processes medical insurance claims from healthcare entities and patients. Think of this as a service that makes sure everyone’s paperwork lines up with what’s covered, what’s not, and who pays what in terms of health insurance coverage. They connect and communicate among health insurance providers, employers, healthcare companies, and people who file health insurance claims for payment. Third-party administrators are experts in their field, and they typically only work with insurance.

Duties of a Third-Party Administrator

Many employers choose to self-fund employee healthcare plans, and technology makes it possible to streamline payments to healthcare providers. However, a third-party administrator takes the hassle out of this process. ClaimLinx ensures everyone fills out the proper forms and that each participant receives the right amount of money. Employers and employees log in to our convenient online system to see their forms, claims status, and finances on a health insurance plan. Our team reduces paperwork and educates everyone on how to file claims for coverage.

What ClaimLinx Does

ClaimLinx accepts claims from employees and providers and processes them to determine the correct payout for the employer and the member. We keep track of each client’s custom schedule of benefits and each member’s usage. Meaning we track who has hit their deductible and through which claims. All of that data lets our team help when it comes to finding new ways to save. Our system works for medical, prescription, dental, and vision coverage. We process claims and payments to providers and members while following strict HIPAA guidelines for privacy. Our team works for you, not for insurance companies. With Claimlinx as your third-party administrator, you and your workers are our top priority.

Hire ClaimLinx as a Third-Party Administrator

ClaimLinx does so much more than serve as a third-party administrator. We offer the security and convenience of all of your healthcare resources in one platform. Our employer benefits consultants teach employees how to take full advantage of their health insurance. Contact ClaimLinx or call toll-free 1-800-858-1772 to find out about the ClaimLinx Solution for your small business.

You offer fantastic health insurance for your employees. It gives them peace of mind for themselves and their families in case they have expensive medical bills. However, the plan couldn’t possibly cover every single type of high-tech MRI scan, prescription medication, or medical procedure. Then secondary coverage comes into play. ClaimLinx explains precisely what secondary coverage is, and how it can save your employees money on their healthcare costs.

What Exactly Is Secondary Coverage?

Simply put, secondary coverage is any health insurance plan that supplements your main plan. Your primary plan usually comes from your employer. ClaimLinx uses secondary coverage as a way to restore good benefits to employees. One of the first steps in using the ClaimLinx Solution is to raise the deductible on the primary plan in order to lower premium costs. But that means employees would have to shoulder most of the costs for office visits, prescriptions, testing, etc. A secondary plan can pay for the medical expenses not covered by your primary plan. This is why secondary health insurance represents a vital tool for helping employees pay for health care. The ClaimLinx Solution sets up a custom secondary plan for your employees, called an employer-funded medical expense reimbursement plan (MERP).

How Does Secondary Coverage Work?

A primary plan pays money directly to healthcare providers while you pay the balance. Secondary coverage pays you directly to reimburse you for expenses not covered by the primary plan. Or secondary coverage can also pay medical providers directly so employees don’t have to. For example, your primary plan covers 60 percent of the costs of an MRI, and you receive a bill for $1,000 for the scan. You must pay the $400 not covered by the primary plan. Your secondary coverage would pay part or all of that $400. The added benefit with ClaimLinx is that employees experience seamless administration. They don’t have to worry about paying that $400 up front. They arrive at the provider’s office with a custom ID card with benefits listed. ClaimLinx then takes care of the rest.

What Does Secondary Coverage Pay?

Secondary coverage might pay for medical care not covered by your primary plan, including eyeglasses or visits to the dentist’s office. A secondary plan may cover copays and coinsurance to help alleviate the costs associated with the primary plan. Some secondary coverage specializes in paying for expenses related to accidents, critical illnesses, cancer, long-term care, and disabilities. ClaimLinx’s Solution aims for employees to receive the same benefits as an expensive plan from a major carrier. Secondary coverage can pay for that, but at a much lower cost.

Why Have Secondary Coverage?

The average person in the United States spends $10,739 per year on healthcare. Secondary coverage can help you spend less money on healthcare, which may insulate your finances from high medical bills. Consider a secondary plan if you know you’ll have high medical expenses in a given year. The ClaimLinx Solution finds the best way for employers to save money while giving workers a great employer-paid benefit.

ClaimLinx and Secondary Coverage

ClaimLinx can save companies as much as 40 percent on health insurance costs. Contact ClaimLinx or call toll-free 1-800-858-1772 to find out what we can do for you.

ClaimLinx offers more than just a way to provide health insurance to your employees. We offer a holistic solution to give great benefits to employees while saving money for business owners. Our ClaimLinx Solution blends a high-deductible insurance plan with a company-funded medical expense reimbursement plan (MERP). The result is an optimized health insurance plan for everyone at your business. ClaimLinx explains how we make this full-service insurance strategy work in today’s blog.

High-Deductible Health Plan

A high-deductible health plan allows for lower monthly premiums. Lower premiums mean you pay less money to have the health insurance plan in place. Normally, higher deductibles mean employees must pay more money before insurance coverage begins to pay for medical expenses. But ClaimLinx has a different strategy.

In 2019, the IRS defined a high-deductible plan as one with at least $1,350 for an individual or $2,700 for a family. These minimums mean individuals must pay the first $1,350 of medical expenses before the health insurance plan starts to cover certain costs. But ClaimLinx typically chooses plans with deductibles much even higher to really slash expenses on premiums. This is a part of our full-service insurance strategy.

MERP

Employers can use a MERP to help fund an employee’s costs before reaching his or her deductible. When paired with a high-deductible plan, MERPs offer a health insurance strategy that is cost-effective for employees and employers.

For example, John Smith goes to the emergency room for a minor injury and receives a bill for $2,500. His insurance carrier sends him an Explanation of Benefits (EOB) that says he owes the full amount because he has not yet met his high deductible of $3,500. John’s employer, Acme Brick, has a MERP that covers emergency room visits with a $350 copay. That means John only pays $350 instead of $2,500.

The ClaimLinx Solution is a win for everyone. John Smith experiences lower costs for medical expenses. Also, John’s employer is happy because he can afford to offer such great benefits since the cost of the company’s monthly premiums has gone down so much. Our full-service insurance strategy identifies the optimal combination of high deductible plan and MERP.

How This Strategy Saves Money

A high-deductible health plan lowers the monthly premiums for each employer. Instead of paying $1,000 per month for a family’s coverage, an employer might pay $700. A MERP continues the savings because it’s a tax deduction. Every time an employer reimburses an employee’s medical expenses, it lowers the amount of money the IRS figures into business taxes. Business owners not only pay lower income taxes, but they also lower onboarding costs by retaining employees for longer periods of time. Employees who remain healthier are more productive and miss less work. ClaimLinx shows you how we deliver for both business owners and employees with our full-service insurance strategy.

Right now — nothing. Aside from a quick, and might I add pretty painful, hit to stock prices of insurance carriers like Cigna, Aetna and UnitedHealth, there won’t be any immediate repercussions.

What can be speculated though is that these three enormous companies will make potentially huge waves as they pull employees off current major carriers’ services. Depleting members reduces the pool of money that insurance carriers will have for their own claims and administration. If the majority of those leaving are young, healthy people, some Americans could see an increase in costs for their insurance plan — on top of already rising prices in the industry overall.

On a more positive note, new enthusiasm and innovation might just be what the industry needs. Having new blood in an incredibly old, often entrenched system might spur creative strategies to encourage savings. Major carriers across the country will have to do something to shore up for the changes this new company could bring.

Ultimately employees of the three companies will benefit first as the new healthcare company will be staged to take care of just them as a starting point. If Bezos statement rings true after this initial step, it may benefit “potentially, all Americans” by providing healthy competition into an ever-shrinking market.

With a language all its own and processes that mystify even veterans of its industry, health insurance is a problem among consumers of all ages.

“People are treating it more like care insurance: you don’t use it until something happens” Kathleen Call, a professor in the University of Minnesota’s School of Public Health, said to Kaiser Health News.

“You have an accident, then you use it. Otherwise you’re trying not to use it. And that’s not the way we want health insurance to be used.”

Explanation of Benefits – A statement, either from your primary insurance carrier or from ClaimLinx, with details about what your plan covers, how much was paid, how much money, if any, is still owed and more.